Medical board revokes license of prolific opioid prescriber

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The state medical board has revoked the license of an East Bay physician who prescribed high amounts of narcotic pain medications to indigent patients, three of whom died while under his care.

Administrative Law Judge Mary-Margaret Anderson concluded that Edward Manougian, 83, prescribed excessive amounts and did little to monitor possible medication abuse or sales on the streets.

“With blinders firmly in place, he conducted his practice in accordance with his own idiosyncratic views and methods, in disregard of the safety of his patients and the public health,” Anderson wrote in a proposed decision adopted last Friday by the state’s medical board.

Manougian declined to comment in detail about the decision, only saying, “What you put out was total lies, and everybody who knows me knows it’s a total lie.”

In July, California Watch examined the medical board's administrative court case against Manougian, who was one of the state’s most prolific prescribers of opioid painkillers to low-income Medi-Cal patients.

Records show that he prescribed doses that were 12 times higher than what pain specialists consider high. One consensus group of pain specialists concluded that prescribing more than 200 milligrams of morphine-equivalent medications per day calls for a thorough reassessment of patient care.

Manougian said he routinely prescribed far more, saying he had a unique understanding of how to help the 240 patients who paid cash at his solo practice in Hercules and Pinole.

In his legal defense, Manougian's attorney, Marvin Firestone, argued that state law says doctors cannot be punished solely for prescribing to patients who are in intractable pain. In an interview, Manougian also said he had a special rapport with patients, who he said were like an extended family.

Anderson acknowledged that doctors can't be disciplined for prescribing alone, but she noted that they are still accountable for unprofessional conduct, negligence or practicing incompetently.

Opioid painkiller prescribing has drawn increasing attention as addiction and overdose deaths have reached what the U.S. Centers for Disease Control and Prevention call “epidemic” levels.

In July, the FBI said it had subpoenaed records from Manougian's office, working with the Health and Human Services Office of the Inspector General and the Drug Enforcement Administration. FBI spokesman Pete Lee said an investigation into his practices is ongoing.

Anderson, the administrative judge, concluded that his patient care was grossly negligent.

Anderson said he erred in the care of Irma Jean Gray, 62, who was found dead on her kitchen floor in January 2010. Anderson said Manougian failed to substantiate the diagnoses he reached to justify giving Gray “excessive amounts of dangerous drugs.”

He also failed to conduct meaningful reviews of her progress or assess her psychological state after she told him that she felt like checking into a mental hospital in the weeks before her death, records show.

Anderson also concluded that Manougian was grossly negligent in his care of Jeanette Dodds, 35, who died of fentanyl toxicity, and Konya Mattie, 41, who died with toxic doses of Xanax and methadone in his system.